Ipratropium, an anticholinergic, is effective in acute COPD exacerbations and should be given concurrently or alternating with beta-agonists. Dosage is 0.25 to 0.5 mg by nebulizer or 2 to 4 inhalations (17 to 18 mcg of drug delivered per puff) by metered-dose inhaler q 4 to 6 h.
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